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The On-ground Reality of Gender-Inclusive Healthcare

Abortion, Queer Rights

April 2022

By Simran

 

What are some barriers gender-queer people face while accessing reproductive healthcare in India?

While abortion is legal in India, it is currently accessible by a very small bracket of pregnant people. The Trans Act 2019 also makes it harder to clarify how queer people could access legal and safe abortion services if they fit the criteria stated by the new MTP Act 2021. Protestors have criticised the Trans Act for having the capability to increase oppression, marginalisation, and transphobia. Trans individuals assert that the Act directly breaches the 2014 NALSA judgement, which embraces self-identification of one’s gender. To have one’s identity recognised, trans people must be ‘certified’ by the district magistrate. Due to the extremely exorbitant costs charged at private health centres and the dearth of consideration at public hospitals, gender affirming surgeries continue to stay a distant hope for several transgender people that wish to undergo surergy.

Most healthcare professionals also only receive medical training which is centreed on the binary sex-gender framework and thus do not know how to treat trans people. They are also exceedingly prejudiced and often let it affect their level of care and professionalism. As a result, there have been accounts of doctors refusing to make contact with trans patients or asking them to undress in order to present their body parts as human specimens for their workmates. Apart from a few legislative developments, the de facto journey of trans people encountering the health system continues to remain detrimental, creating a tremendous obstacle to seeking health care.

According to a youth-led evaluation of sexual and reproductive health services in Lucknow, the public health sector severely lacks the infrastructure needed to deliver reliable sexual health services to young adults. Service practitioners are overwhelmed with labor and are extremely traditional once it gets down to delivering sexual health data and facilities. This encompasses emergency contraception, HIV consultation, and abortion facilities. When young adults attempt to utilise such facilities, they are frequently forced to answer intrusive inquiries about their personal lives, such as their marital status and sexuality. It is not only demeaning for them, but it also hinders their health-seeking tendencies.

 

Are people of varying sexualities able to access these services?

When it comes to sexual healthcare facilities; lesbian, gay, and bisexual (LGB) individuals encounter stigma and discrimination. This is due to cultural and societal perceptions, as well as prejudice associated with sexual actions involving LGB people. Traditionally, health care providers and physicians question women on whether they are married instead of whether they are sexually active. Even when a single cis-woman seeks healthcare, she has to think of the potential consequences such as facing embarrassment,  slandering, or bewilderment by service providers.

The circumstance of lesbian and bisexual women who are not married to men is aggravated in this frame of reference, as it becomes unsafe and challenging to divulge that they do not have a male partner. They are also subjected to discriminatory practices due to how they choose to look or dress.

Furthermore, all domestic laws and policies reaffirm a cis-heteronormative family and societal framework, making same-sex relationships unavailable and thus unconstitutional. It, therefore, renders the simple act of seeking healthcare services exceedingly challenging for LGB people who openly express their sexual orientation. It further promotes an environment of exclusion, discrimination, and anxiety, which scars people’s identities and self-esteem and also has a detrimental influence on their overall well-being.

Queer people require access to equitable healthcare services, policies, and research that address their needs. While engaging with medical professionals, gender-queer individuals have encountered and reported various patterns of aggression, prejudice, stigma, and inequitable obstacles in an attempt to access safe healthcare services. As a result, it is imperative to readjust the current sexual and reproductive health structure and facilities in order to provide more equitable, inclusive, and discrimination-free healthcare services.

 

What are some risk factors India should be focusing on more?

The lack of focus on sexual and reproductive healthcare for people in India becomes apparent with the absence of recent research and attention being paid to the rising issues pregnant people face. While India has announced its aspiration of meeting United Nation’s Sustainable Development Goals (UN-SDGs) that help curb India’s maternal mortality rate, the focus still remains only upon women. Additionally, the MTP Act is extremely restrictive; it doesn’t allow every pregnant person to avail of safe abortion services in India. Even with the special clauses placed, pregnant people seeking abortion under the clauses of being minors or being sexually assaulted can be refused by the doctor since each state has the jurisdiction to overlook such cases.

Abortion has been legal for women in India since the early 1970s but rural women are especially at risk of undergoing an unsafe abortion. While privacy is ensured for women over 18, those under 18 are not provided the confidentiality clause, which puts young women (aged 15-19) at the highest risk of fatal consequences from an abortion-related complication. This poses a bigger risk for queer people who may come from queerphobic families or may not wish to come out to their parents yet, since it could invite the risk of violence and even homelessness. The MTP Act is also extremely ableist in nature by allowing no upper gestation limit for the cases where the fetus has an “anomaly”.

 

Other issues with the MTP Act and its implications on under-served communities:

The MTP Act disproportionately impacts people from marginalised castes (such as Dalit, Bahujan, and Adivasi folks) and people from rural backgrounds, by mandating a third-party authorisation for abortions after passing a 24-week gestation period. Such authorisations require varying expenses for services and travel which most marginalised communities cannot afford. There are also very few public health centres that provide the necessary facilities to trans folks undergoing transitions through hormones and surgeries, which can also be incredibly expensive. This adds to the barriers queer individuals face while trying to access safe and equitable healthcare facilities in India.

With the current exclusive healthcare practices and use of the language of laws and policies governing our country, it is important to remember that any individual with a uterus, not just a woman, should have safe access to reproductive healthcare facilities.

About the Campaign

This article is a part of a campaign that highlights the various barriers queer-trans* individuals face in accessing basic, abortion-based healthcare services and the role the MTP Act plays in it. It also speaks extensively of how these challenges affect the Indian demographic and the country’s current healthcare framework.
This campaign has been created by Simran, a Media Campaign Fellow with The YP Foundation.

About the author

Pursuing their Master’s degree in Applied Psychology, working as a Content Writer at The Swaddle, Copywriting at Lekh Haq, and graphic designing on the side, Simran (they/them) loves dipping their toes in every opportunity they can find. They were inspired to participate in TYPF’s SAFE Campaign to bring more attention to queer reproductive health issues.

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